Jake Dorst, CIO, Tahoe Forest District Hospital, Chapter 2

One of the most important characteristics for a strong leader is being able to stay calm when the organization hits rough waters. For Jake Dorst — who has survived tumultuous times during his career, including acquisitions and difficult go-lives — the ultimate test came less than a year into his tenure at Tahoe Forest Hospital District, when he was asked to serve as interim CEO. And although he learned quite a bit from the experience, he’s happy to be back in the CIO shoes that seem to fit him so well.

In this interview, Dorst talks about how his team is preparing for an Epic go-live (and why they chose to partner with Mercy Health’s IT services arm), why they’re focusing on “Population Wellness” rather than population health, the challenges of being located in a resort area, and why it’s essential to have a strong project manager. He also discusses why Tahoe Forest appealed to him, his “servant leadership” philosophy, and what it was like to move across the country with young children.

We were able to risk stratify through claims data, biometric screening, and up-to-the-minute wearable data to do what we call ‘Population Wellness.’ It’s not really population health; it’s a lot of the low-hanging fruit that I think gets bypassed in the population health world, where they dive right into genomics and you have to hire data scientists.

When you’re talking about innovation, a lot of times it involves this new world of data science and big data and all the buzzwords that drive me nuts — machine learning, artificial intelligence. My question is, how effective is it?

If you put the patient first, you’re going to do okay. This is a play to make the patient first; to put their records all in one place, make it easy for them to get treatment here and elsewhere, and give our physicians, nurses and caregivers the best tools that they can have to get a longitudinal look at what’s going on with the particular person.

One of the doctors said, ‘if we could come up with a way to do that at home, that would be great.’ That’s where that rural health and research comes into play. It’s one of the things that really intrigued me when I was interviewing for this position — that this organization would put money towards those types of things.

Gamble: Looking down the road, once you have that unified record in place, I imagine you start looking at initiatives like population health or anything that’s going to be made easier by having that unified record.

Dorst: Yes, and we’re doing a lot of that here now. We’ve started a program called Blue Life based on Blue Zones — the predominant color here up in Tahoe area is blue. People identify with that color. We found one of the benefits of working here is its proximity to Silicon Valley. There are a lot of younger semi-retired folks or fully retired folks that live up here and still have a lot of work left in them. We came across a startup here that was doing wearable technologies and had created a mobile-first social platform.

He approached us about how we could use it for the hospital, and so we actually built a product with him for our own self-insured folks to track health insurance information, live, up-to-date information from Fitbits and wearables, and our eight years of biometric screening that we’ve been doing with our employees. We were able to risk stratify through claims data, biometric screening, and up-to-the-minute wearable data to do what we call ‘Population Wellness.’ It’s not really population health; it’s a lot of the low-hanging fruit that I think gets bypassed in the population health world, where they dive right into genomics and you have to hire data scientists. And yet, you’ve got all these people who might still be smoking and their cholesterol is high or their BMI is high.

Those are the types of things we’ve decided to focus on. It’s the things that we can actually affect with our own employee population. In turn, we hope that if we can avoid admissions or health problems, we can reduce our own cost for our own health program. And as we get that wired — and we’re seeing good results with that now — we want to open that up and roll that out to our local population.

Gamble: Right. And they can use this app to help manage their health?

Dorst: Yes. The app is free to anybody that wants to use it, but we push it out for our population here — our beneficiaries and their families. Everybody who is covered under our plan can sign up for health coaching if they meet the criteria. For example, if they have four high-risk categories, we’ll ask them if they want to be coached, and we can help them with our wellness team to make better life choices and help reduce numbers, or increase depending on what it is, and get them out of the red, so to speak.

We also have things like public walking challenges and hydration challenges, and we’ve have pretty good turnouts. We see amazing competitiveness among people when we start these challenges, but it’s a really fun app. We’ve had fun doing it.

One of the things that really attracted me to this hospital when we were in the market for a new job was the innovation taking place here, and that they’re willing to embrace it. It’s really refreshing and very different from other places that I’ve worked.

Gamble: That’s in your title, which is interesting. You’re the Chief Information and Innovation Officer, and so I would guess it’s a big part of your focus. And by having that as your title, it’s not separating the two out, which is something that happens a lot. Do you think that’s something we could to see more of in terms of those two roles being married?

Dorst: I think so. When you’re talking about innovation, a lot of times it involves this new world of data science and big data and all the buzzwords that drive me nuts — machine learning, artificial intelligence. My question is, how effective is it? I go back to our example with Blue Life. I don’t want to skip over the fundamentals of health that we know actually help people by losing weight, like cutting cholesterol. If you’re pre-diabetic, how can we keep you from being a diabetic?

Those types of things are not hard to track. If you do the right interventions, you can actually make progress with those types of things. And it doesn’t take Hadoop, and machine learning, and data scientists. I hate to see big hospitals skipping over those things and going straight into, ‘let’s find the one out of one million genetic disorder that we’re going to help.’ It’s good to find that person and be able to save that person or help them, but what about all the other folks that are going to be a burden on your system down the road? I think as we see more of the value-based payment come into play, hopefully that paradigm will shift a little bit.

Gamble: So all off this feeds into the goal Tahoe Forest had set out in creating a unified record and getting all this data in the same place.

Dorst: Right, getting it all in the same place. Again, and I say this a lot, if you put the patient first, you’re going to do okay. This is a play to make the patient first; to put their records all in one place, make it easy for them to get treatment here and elsewhere, and give our physicians, nurses and caregivers the best tools that they can have to get a longitudinal look at what’s going on with the particular person.

Gamble: And once you’re past go-live, are there plans to go into some of the other Epic offerings?

Dorst: Yes, and that’s a big driver for us. Another reason we partnered with Mercy is they’ve got a big virtual play. They built a virtual health center in St. Louis, which is amazing. By partnering with them, we’ll have access to those offerings as well, which will help us in a rural setting. So that was very attractive as well. In my mind, looking out five to 10 years from now, I think we’re going to see telemedicine become a lot more utilized than it is currently.

Gamble: You mentioned briefly before that you’ve done some telemedicine work with UC Davis. Is that for a specific disease area?

Dorst: We’re a UC Davis Rural Center of Excellence. We might be the only one. I think there’s another hospital applying for it, but there are basically three legs of the stool for that. The first part is teaching. We have students come up from UC Davis that do a rotation to see what rural medicine looks like. That’s one part of it.

And we do research as well. We have the Tahoe Institute for Rural Health Research, which was the brainchild of some of the forward-thinking folks that were here prior to me. They put some money into this LLC to go out and find problems and then try to fix them with technology, instead of the other way around. What usually happens is someone invents a technology, and then you’ve got to go find a problem for it.

We’ve had very big success working on a portable blood count monitoring system — we were able to get some grant funding for that through the National Science Foundation. We’re working with some of the traumatic brain injury diagnosis because of where we’re located. These were things that were brought to us. And we’re also looking at home blood monitoring for the CBC, because we’re in a rural location.

One of our main service lines here is cancer treatment, for which we also partner with UC Davis. If you’re 45 minutes away and you have to come in for chemo and you have to get your white blood cell count before you do that and it’s high, you’ve then got to go back home. It’s very time-consuming and it’s bad, especially for people that are sick.

So one of the doctors said, ‘if we could come up with a way to do that at home, that would be great.’ That’s where that rural health and research comes into play. It’s one of the things that really intrigued me when I was interviewing for this position — that this organization would put money towards those types of things. Because the idea is if we could get some of these things to work and really be a commercial success, that will help the hospital stay relevant for this community for a longer period of time, based on any kind of uncertainty that we see out there with the ACA and those types of things.

And so, going back to your initial questions, we do telemedicine with our cancer program. Dr. Larry Heifetz is the champion of this. He actually did a presentation down in Nashville recently on what we call the Synaptic Network where we partnered with all of these other cancer treatment centers.

When you come here as a rural patient, your case is going to get reviewed by at least 20 oncologists. On the first four days of the week, that captures 80 percent of all cancers, including breast, skin, and GI. Every day is dedicated to a specific type of cancer. The way it’s set up, there are two large screens. One of them looks like Hollywood Squares with 20 doctors on it, and then the other one is your chart. And they go over the entire chart, come up with a treatment plan, and work it all out. So, you’re in a rural setting but you’re really getting world-class cancer treatment diagnosis and treatment planning here at Tahoe Forest.

Gamble: Right. You had said telemedicine is something you think is finally starting to take off. It really has seen its share of starts and stops over the years. Do you think we’re reaching a point where we’re going to be able to get over that hump?

Dorst: Yes, because now you’re seeing insurance companies offer it. I think once that starts happening, it’s going to be just become commonplace. I was just reading that Teladoc is up 68 percent over the last quarter. So it’s definitely growing. There are more subscriptions and partnerships coming together. The main drawback with telemedicine is that no one figured out how to make money off of it with the state regulations and federal regulations. I think those are starting to go away, or at least be minimized via technology in a way that it makes sense now for folks to start doing it.

In terms of the telemedicine we’re doing here, we have teleneurology and those types of things, but our cancer center is a little unique in the fact that it grew up around this program. And it’s a model that Dr. Heifetz is really trying to push out to the rest of America to get everybody the topnotch cancer treatment that they deserve.